Thumb Sucking
Thumb sucking is a normal behavior in early infancy whose incidence peaks at 18 to 21 months of age. It
is generally viewed as a biologic drive that develops into a habit. It
typically resolves by 4 years of age, but it can persist
much longer. Problems associated with thumb sucking depend on the habit's
duration, intensity, and frequency and can include
malocclusion; paronychia; infection; digital hyperextension, soreness, and
callous formation; accidental poisoning; and psychosocial issues. Many
parents do not approve of the behavior and some will criticize, ridicule, or
punish thumb suckers. Children who suck their thumbs often are viewed as less
fun, happy, likable, attractive, intelligent, and desirable as friends or
classmates.
Thumb sucking treatment may be considered when any of the
problems listed previously affect the child's physical or psychosocial
well-being.
Treatment is not considered necessary
before 4 to 6 years of age. Options include orthodontic
appliances, physical barriers, aversive taste treatments, and when appropriate,
psychological counseling. Orthodontic
appliances, although effective, are very expensive.
Physical barriers, such as
mittens or socks, have variable rates of success.
Topical aversive therapies
(special nail polishes) may work, but only with the child's approval. Thumb
sucking and other chronic habits may be markers for
anxiety or stress that might require an evaluation of the child's and
family's psychosocial functioning. Most thumb sucking in childhood is harmless
and self-limited and does not require directed intervention.
References:
Friman PC, McPherson KM, Warzak WJ, Evans J. Influence of thumb sucking
on peer social acceptance in first-grade children. Pediatrics.
1993;91:784-786
Johnson ED, Larson BE. Thumb sucking: classification and treatment. ASDC
J Dent Child. 1993;60:392-398
Peterson JE Jr, Schneider PE. Oral habits: a behavioral approach.
Pediatr Clin North Am. 1991;38:1289-1307